Provider Demographics
NPI:1437203924
Name:GREEN, CHERYL ANN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 262
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2139
Mailing Address - Country:US
Mailing Address - Phone:361-570-8900
Mailing Address - Fax:361-570-8903
Practice Address - Street 1:1501 E MOCKINGBIRD LN
Practice Address - Street 2:SUITE 262
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2139
Practice Address - Country:US
Practice Address - Phone:361-570-8900
Practice Address - Fax:361-570-8903
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0127471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000S09YMedicare ID - Type Unspecified